Economic evaluation of user-fee exemption policies for maternal healthcare in Burkina Faso: evidence from a cost-effectiveness analysis

Hoa Thi Nguyen, Aleksandra Torbica, Stephan Brenner, Joel Arthur Kiendrébéogo, Ludovic Tapsoba, Valery Ridde, Manuela De Allegri

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    Objectives: The reduction and removal of user fees for essential care services have recently become a key instrument to advance universal health coverage in sub-Saharan Africa, but no evidence exists on its cost-effectiveness. We aimed to address this gap by estimating the cost-effectiveness of 2 user-fee exemption inte rventions in Burkina Faso between 2007 and 2015: the national 80% user-fee reduction policy for delivery care services and the user-fee removal pilot (ie, the complete [100%] user-fee removal for delivery care) in the Sahel region.

    Methods: We built a single decision tree to evaluate the cost-effectiveness of the 2 study interventions and the baseline. The decision tree was populated with an own impact evaluation and the best available epidemiological evidence.

    Results: Relative to the baseline, both the national 80% user-fee reduction policy and the user-fee removal pilot are highly cost-effective, with incremental cost-effectiveness ratios of $210.22 and $252.51 per disability-adjusted life-year averted, respectively. Relative to the national 80% user-fee reduction policy, the user-fee removal pilot entails an incremental cost-effectiveness ratio of $309.74 per disability-adjusted life-year averted.

    Conclusions: Our study suggests that it is worthwhile for Burkina Faso to move from an 80% reduction to the complete removal of user fees for delivery care. Local analyses should be done to identify whether it is worthwhile to implement user-fee exemptions in other sub-Saharan African countries.

    Original languageEnglish
    JournalValue in Health
    Issue number3
    Pages (from-to)300-308
    Number of pages9
    Publication statusPublished - 2020


    • Burkina Faso
    • economic evaluation
    • facility-based delivery
    • maternal care
    • user-fee exemptions
    • IMPACT
    • EQUITY

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